ABSTRACT
Intracardiac right to left shunt through a patent foramen ovale (PFO) may result in the development of hypoxemia after cardiac surgery. Cardiac tamponade and mechanical ventilation with high positive endexpiratory pressure are the most common factors responsible for enhancing intracardiac right to left shunt through a PFO. We report an 83-year-old woman with Stanford type A dissecting aneurysm who developed hypoxemia and paradoxical air embolism after reconstruction of ascending aorta and Bental's procedure. Transesophageal echocardiography (TEE) revealed right to left shunting via a PFO. Surgical closure of the PFO was done without delay. This case illustrates the role of TEE in prompt diagnosis of intracardiac right to left shunting through a PFO causing postoperative hypoxemia after cardiac surgery.
Subject(s)
Echocardiography, Transesophageal , Heart Septal Defects, Atrial/diagnostic imaging , Hypoxia/etiology , Postoperative Complications , Aged, 80 and over , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Embolism, Air/etiology , Female , HumansABSTRACT
A 68-year-old female who underwent right ulnar nerve transposition surgery under axillary block (AB) by dual-technique (paresthesia and axillary artery penetration techniques) developed postoperative wristdrop. Physical examination showed local hematoma formation with ecchymosis at her right axillary region. Both ultrasonography and nerve conduction studies on her brachial plexus revealed neither direct hematoma compression, intraneural hematoma, nor peripheral neuropathy. Fortunately, she was completely restored to her right hand function 20 h after anesthesia, and was discharged without sequelae 17 days later. In this case, delayed recovery of radial nerve function after AB was suspected and the mechanism which led to this unusualness is discussed.
